THE RETURN OF TETANUS TO KYRGYZSTAN AFTER 20 YEARS OF WELL-BEING



Cite item

Full Text

Abstract

Tetanus is a rare but highly dangerous vaccine-preventable disease with a high mortality rate. Previous tetanus infection does not protect against reinfection, and antitoxin immunity must be maintained throughout life through routine immunization, which is often overlooked by adults, while children are sometimes deprived of protection against tetanus due to the actions of their parents. Objective: To analyze the causes of tetanus in children, identify problems associated with diagnosis and treatment, and assess the level of vaccination in the country to improve primary and secondary prevention of the disease. Materials and Methods. To study the level of vaccination in Kyrgyzstan, we used data from reports of the Republican Center for Immunoprophylaxis of the Kyrgyz Republic (RCI KR), information posted on the websites of the WHO, the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC). To examine the clinical and epidemiological data of two clinical cases, we reviewed the medical records of patients who were treated in infectious disease hospitals (Bishkek and Osh). Results. In Kyrgyzstan, coverage with the third dose of DPT vaccine under the National Immunization Schedule has fallen below the target of 95% since 2019, fluctuating between 86-90% over the past three years. In 2023, the number of children who did not receive immunization increased by 31.8% compared to 2019. Most parents refuse to vaccinate their children for religious reasons (50-62%), with doubts about the safety of the vaccines themselves coming second. With the non-immune segment of the population expanding, especially among children, the resurgence of nearly forgotten vaccine-preventable diseases is inevitable. The example of two clinical cases of generalized tetanus in children demonstrates the healthcare system’s unpreparedness to deal with a long-forgotten disease. Conclusion. The only reliable way to protect against tetanus is timely routine vaccination of children and adults according to the National Immunization Schedule and complete primary and secondary surgical treatment of wounds. Early diagnosis of tetanus, knowledge of its symptoms, and collection of an epidemiological history are essential. Every infectious disease hospital should have a supply of at least 100,000 IU of tetanus vaccine for one patient.

About the authors

Elena Anatolyevna Radchenko

Kyrgyz State Medical Academy named after I.K. Akhunbaev

Email: radeandom@mail.ru
ORCID iD: 0009-0001-8065-3006

PhD, Associate Professor; Associate Professor at the Department of Pediatric Infectious Diseases

Kyrgyzstan, st. I. Akhunbaeva, 92, Bishkek, 720020

Umida Akbaralievna Khudaiberdiyeva

Osh City Clinical Hospital

Email: aisiya17@mail.ru

physician, head of the intensive care unit of the infectious diseases hospital

Kyrgyzstan, 157 K. Datka Street, Osh, Kyrgyz Republic, 723500

Gulbara Satygulovna Ishenapysova

Republican Center for Immunization Prevention of the Ministry of Health and Social Development of the Kyrgyz Republic

Email: ishenapysova@mail.ru
ORCID iD: 0000-0003-1356-6321

Director of the Republican Center for Immunoprophylaxis of the Ministry
 of Health and Social Development of the Kyrgyz Republic.
Kyrgyzstan, 535 Frunze Street, Bishkek, Kyrgyz Republic, 720000

Kalys Asanbekovna Nogoibaeva

Kyrgyz State Medical Academy named after I.K. Akhunbaev

Author for correspondence.
Email: k.nogoibaeva2014@gmail.com
ORCID iD: 0000-0003-0673-872X
Scopus Author ID: 26640604900

Doctor of Medical Sciences, Acting Head of the Department of Research
Management; Associate Professor of the Professorial Course on Infectious
Diseases
Kyrgyzstan, st. I. Akhunbaeva, 92, Bishkek, 720020

References

  1. Атлас наблюдения за инфекционными заболеваниями 2024.
  2. Европейский центр по профилактике и контролю заболеваний ECDC; Atlas of Communicable Disease Surveillance
  4. European Centre for Disease Prevention and Control (ECDC);
  5. https://atlas.ecdc.europa.eu/public/
  6. Европейский портал информации здравоохранения «Здоровье для всех» (HFA) European Health Information Portal "Health for All" (HFA) https://gateway.euro.who.int/en/datasets/european-health-for-all-database/
  7. Клинический протокол диагностики и лечения «Столбняк» утвержденный Объединенной комиссией по качеству медицинских услуг МЗ Республики Казахстан от «12» мая 2017 года. Протокол №22. Clinical protocol for the diagnosis and treatment of "Tetanus" approved by the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan on May 12, 2017. Protocol No. 22.
  8. https://medelement.com/ https://diseases.medelement.com/disease/%D1%81%D1%82%D0%BE%D0%BB%D0%B1%D0%BD%D1%8F%D0%BA/15026
  9. Клиническое руководство по диагностике и лечению столбняка (для всех уровней организаций здравоохранения). Приложение 3 к приказу МЗ КР №1023 от “23” августа 2022г. Clinical guidelines for the diagnosis and treatment of tetanus (for all levels of healthcare organizations). Appendix 3 to Order No. 1023 of the Ministry of Health of the Kyrgyz Republic dated August 23, 2022. https://www.med.kg/clinicalProtocols
  10. Княгина О.Н., Шарабакина М.А., Цветкова Н.А. Европейская неделя иммунизации: итоги и проблемы. Медицинский альманах. 012;(3):161–5. Knyagina O.N., Sharabakina M.A., Tsvetkova N.A. European Immunization Week: Results and Challenges. Medical Almanac.2012;(3):161–5. https://cyberleninka.ru/article/n/evropeyskaya-nedelya-immunizatsii-itogi-i-problemy
  11. Комаровская Е.И., Проскурина О.В. Столбняк у не привитых лиц: обзор клинических случаев. БИОпрепараты. Профилактика, диагностика, лечение. 2025;25(1):47–57 Komarovskaya E.I., Proskurina O.V. Tetanus in unvaccinated persons: A review of case reports. Biological Products. Prevention, Diagnosis, Treatment. 2025;25(1):47–57. https://doi.org/10.30895/2221-996X-2025-25-1-47-57
  12. Ларина Н. Е., Люхин М. Ю., Нестерова А. Р. и др. Опыт успешного лечения ребенка с генерализованной формой столбняка в условиях отделения анестезиологии и реанимации // Children's medicine of the North -West. 2025;13(1): 233-239. Larina N. E., Lyukhin M. Yu., Nesterova A. R., et al. Experience of successful treatment of a child with generalized tetanus in the anesthesiology and resuscitation department // Children's medicine of the North-West. 2025;13(1): 233-239.
  13. DOI:https://doi.org/10.56871/CmN-W.2025.11.71.021
  14. https://scinetwork.ru/articles/29828
  15. Лобзин Ю.В. Руководство по инфекционным болезням. Санкт-Петербург, 2000. Часть 1.188с.
  16. Lobzin Yu.V. Handbook of Infectious Diseases. St. Petersburg, 2000. Part 1, 188 pages.
  17. https://studfile.net/preview/1904427/page:19/
  18. Мельник Г.В., Намитков Х.А., ред. Столбняк: Учебно-методическое пособие. Краснодар: Издательство КГМА; 2002.
  19. Melnik G.V., Namitkov H.A., eds. Tetanus: A Textbook-Method Manual. Krasnodar: KSMA Publishing House; 2002.
  20. https://mkgtu.ru/vikon/sveden/files/Stolbnyak._Posobie_dlya_studentov,_ordinatorov,_vrachey(1).pdf
  21. Намитоков Х.А. Столбняк. Майкоп: 2016. 53 с. Namitokov Kh.A. Tetanus (Manual for students, residents, and doctors). - Maikop: 2016. 53 p https://mkgtu.ru/vikon/sveden/files/Stolbnyak._Posobie_dlya_studentov,_ordinatorov,_vrachey(1).pdf
  22. Портал данных иммунизации ВОЗ WHO Immunization Data Portal https://immunizationdata.who.int/
  23. Петлах В.И. Столбняк у детей: современная концепция управления инфекциейональное руководство. Альманах клинической медицины. 2018; 46 (2): 160–170 Petlakh VI. Tetanus in children: current concepts of the infection management. Almanac of Clinical Medicine. 2018;46(2):160-70. https://cyberleninka.ru/article/n/stolbnyak-u-detey-sovremennaya-kontseptsiya-upravleniya-infektsiey
  24. doi: 10.18786/2072-0505-2018-46-2-160-170
  25. Петров С. В. Общая хирургия. —М.: ГЭОТАР-Медиа, 2014. — 832 с
  26. Petrov S. V. General surgery. - M.: GEOTAR-Media, 2014. - 832 p.
  27. https://ru.scribd.com/document/609509783/%D0%9E%D0%B1%D1%89%D0%B0%D1%8F-%D0%A5%D0%B8%D1%80%D1%83%D1%80%D0%B3%D0%B8%D1%8F-%D0%9F%D0%B5%D1%82%D1%80%D0%BE%D0%B2-%D0%A1-%D0%92-2014-%D0%B3
  28. Симованьян Э. М., Гончарова Е. Л., Денисенко В. Б. Трудности диагностики столбняка у детей// Детские инфекции. 2019; 18(4):70-72 Simovanyan E. M., Goncharova E. L., Denisenko V. B. Difficulties in diagnosing tetanus in children// Children's Infections. 2019; 18(4):70-72 https://doi.org/10.22627/2072-8107-2019-18-4-70-72
  29. Учайкин В.Ф., Шамшева О.В. Инфекционные болезни у детей. – М.: ГЭОТАР-Медиа, 2022. – 920 с. Uchaikin V.F., Shamsheva O.V. Infectious diseases in children. - M .: GEOTAR-Media, 2022 .-- 920 p.
  30. doi: 10.33029/9704-5654-5-IBD-2021-1-920.
  31. Чечетова С.В., Кадырова Р.М., Джолбунова З.К., Халупко Е.А., Чыныева Д.К., Карамурзаева Г.А., Малышева М.А. Динамика забоеваемости вакциноуправляемых инфекций за последние 20 лет в Кыргызстане// Евразийский журнал здравоохранения. 2022; 1(1): 119-128. Chechetova S.V., Kadyrova R.M., Dzholbunova Z.K., Khalupko E.A., Chynyeva D.K., Karamurzaeva G.A., Malysheva M.A. Dynamics of Vaccination-Preventable Infections in Kyrgyzstan over the Past 20 Years// Eurasian Journal of Health Care. 2022; 1(1): 119-128. doi: 10.54890/1694-6405_2022_1_119
  32. Юнусов Т.А, Радченко Е.А. Клинический случай генерализованной формы столбняка у ребенка. В кн.: Технологические инновации и научные открытия. Уфа; 2023; с:188-198. Yunusov T.A, Radchenko E.A. Clinical case of generalized tetanus in a child. In: Technological innovations and scientific discoveries. Ufa; 2023 (In Russ.). EDN: CPCJDM
  33. https://perviy-vestnik.ru/wp-content/uploads/2023/04/2023-K-367-2-04_23.pdf
  34. Ющук Н.Д., Венгеров Ю.Я. Инфекционные болезни: национальное руководство. – М.: ГЭОТАР-Ме диа, 2009. – 1056 с. Yushchuk N.D., Vengerov Yu.Ya. Infectious diseases: national guidelines. – M.: GEOTAR-Media, 2009. – 1056 p.
  35. https://jasulib.org.kg/wp-content/uploads/2022/04/1.Uyshuka-N.D-Infeksya-bol.pdf
  36. Barlas ÜK, Kıhtır HS, Yeşilbaş O, Petmezci MT, Akçay N, Petmezci E, et al. Tetanus, a forgotten infection disease: a report of two cases. Turk J Pediatr. 2020;62:274-9. https://pubmed.ncbi.nlm.nih.gov/32419420/
  37. doi: 10.24953/turkjped.2020.02.014
  38. Deniz M. and Erath T. (2023). Generalized tetanus: a pediatric case report and literature review. Revista do Instituto de Medicina Tropical de São Paulo, 65
  39. https://doi.org/10.1590/S1678-9946202365040
  40. https://www.scielo.br/j/rimtsp/a/MhvcYyfbfVJSBDjtCq6xfGj/?lang=en
  41. Fan J., Zhao Y., Wang S., Zhang F., Zhuang K.
  42. Clinical features and outcomes of tetanus: a retrospective study. Infect Drug Resist, 12 (2019), pp. 1289–1293, 10.2147/IDR.S204650 https://pubmed.ncbi.nlm.nih.gov/31190917/
  43. Guidance on the management of suspected tetanus cases and the assessment and management of tetanus-prone wounds. UK Health Security Agency; 2024.
  44. https://www.gov.uk/government/publications/tetanus-advice-for-health-professionals/guidance-on-the-management-of-suspected-tetanus-cases-and-the-assessment-and-management-of-tetanus-prone-wounds
  45. Henok Tadele. Clinical Profile and Outcome of Pediatrics Tetanus: The Experience of a Tertiary Hospital in Ethiopia. J Health Sci.2017;27(5):559. DOI: http://dx.doi.org/10.4314/ejhs.v27i5.14
  46. https://pubmed.ncbi.nlm.nih.gov/29217961/
  47. Rodrigo C, Fernando D, Rajapakse S: Pharmacological management of tetanus: an evidence-based review. Crit Care. 2014, 18:217. 10.1186/cc13797
  48. https://pubmed.ncbi.nlm.nih.gov/25029486/
  49. doi: 10.1186/cc13797
  50. Sharma N, Li S, Sravanthi MV, Kazmierski D, Wang Y, Sharma A, Dhaubhadel P: Tetanus complicated by dysautonomia: a case report and review of management. Case Rep Crit Care. 2021, 2021:8842522. 10.1155/2021/8842522 https://pmc.ncbi.nlm.nih.gov/articles/PMC7987407/
  51. doi: 10.1155/2021/8842522
  52. Sudarshan R, Sayo AR, Renner DR, De Saram S, Godbole G, Worrell S, Duong HT, Thwaites KL, Mehta AR, Coughlan S. Tetanus: recognition and management. The Lancet Infectious Diseases. June 18, 2025 https://pmc.ncbi.nlm.nih.gov/articles/PMC7617864/
  53. Tetanus reported cases and incidence. WHO; 2024. https://immunizationdata.who.int/global/wiise-detail-page/tetanus-reported-cases-and-incidence
  54. Tetanus surveillance – United States, 2024. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/tetanus/php/surveillance/index.html
  55. Tetanus: World Health Organization, 2024
  56. https://www.who.int/news-room/fact-sheets/detail/tetanus
  57. Van Hao N, Loan HT, Yen LM, Kestelyn E. et al. Human versus equine intramuscular antitoxin, with or without human intrathecal antitoxin, for the treatment of adults with tetanus: a 2 × 2 factorial randomised controlled trial. Lancet Glob Health. 2022 Jun;10(6):e862-e872. doi: 10.1016/S2214-109X(22)00117-6. PMID: 35561721; PMCID: PMC9115864.I: 10.24953/turkjped.2020.02.014 doi: 10.1016/S2214-109X(22)00117-6
  58. https://pubmed.ncbi.nlm.nih.gov/35561721/

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) Radchenko E.A., Khudaiberdiyeva U.A., Ishenapysova G.S., Nogoibaeva K.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 64788 от 02.02.2016.